Introduction

WebAIRS (web-based Anaesthetic Incident Reporting System) was established as a voluntary online incident reporting system for anaesthetists in Australia and New Zealand in September 2009. Its stated purpose is to improve patient safety and the quality of anaesthesia by capturing, analysing and disseminating information about (de-identified) anaesthesia-related safety incidents. By mid-2016, over 4000 anaesthesia incident reports had been received, and a variety of reports published on the data, including an exploration of patient and procedural factors influencing the outcome of incidents, and analyses of specific incident types, such as those related to awareness, airway events, aspiration, and most recently, medication errors. This month online data from the second 4000 incidents reported to webAIRS was published [1]. There was little difference in the categorisation or outcomes of the events between the first cohort of 4000 patients, and the second. Summary of Findings

• Reported incidents occurred across all age groups, with a peak incidence in the 60-69 year old age group.
• There was an even distribution across gender.
• Over 40% of incidents took place in patients graded ASA 1&2, and about 1/3 in patients with a BMI of 18-25.
• Most incidents occurred during daytime operating hours (82.9%), with less than 5% happening after 22.00.
• About 72% of incidents occurred in an operating theatre or anaesthesia induction room, 8% in a post-anaesthesia care unit, and 11% at a site remote from the operating theatres (e.g. gastroenterology, cardiology or radiology suite).
• Respiratory or airway events were the most frequently reported incident category (33%), followed by cardiovascular (17.2%) and medication errors (17%). Neurological incidents accounted for 6.2%.
• Incidents were associated with unplanned intensive care unit (ICU) or high dependency unit (HDU) admission in 18% of cases, prolonged hospital length of stay in a further 6%, and cancellation of a procedure in about 6% of cases.
• 27.8% of incidents were associated with some patient harm, and 4.7% involved a patient death. (However, this is not to say that the incidents definitely caused the harm or the death - in many instances the harm or death may have been inevitable or unrelated).
• Just under 50% were regarded (by the reporting anaesthetist) to have been preventable. The paper’s authors point to the usual caveats that apply in relation to extrapolating from voluntarily provided data for which there is no reliable denominator. Whether or not the incidents are representative of all anaesthesia incidents occurring across Australia and New Zealand cannot be determined using this model. However, this in no way means that the data are not relevant. The fact that there is little difference between the two datasets indicates that the data obtained accurately represents incidents considered worth reporting by the (now) 210 sites. The combined 8000 cases is amongst the largest datasets of de-identified anaesthesia incidents reported. It is interesting to note that reports to webAIRS are being submitted at an increasing rate. The first case was reported in September 2009, the 4000th about 82 months later; the time taken for the reporting of the 2nd 4000 cases was approximately 46 months. The number of sites reporting over this period increased from 134 to 210 (168 in Australia and 42 in New Zealand). It is possible that the rise in pace of case submissions represents a substantial increase in event frequency. However, it is more likely to indicate a growing trust in the safety, anonymity, and value of the reporting process and subsequent analysis. The benefit of recording and publicising such data lies in its utility to best direct where technical fixes, educational attention, research and other resources might go in order to prevent or reduce the incidence of, or otherwise manage, such incidents. It should also spur other countries, including Ireland, to consider gathering similar incident or safety data. The first article in this issue examines Kim et al’s recent publication on medication events from the webAIRS database [2]. Why focus on medication error (again)? In the overall webAIRS dataset, reporting anaesthetists deemed the incident to have been preventable in about 50% of cases; in respect of medication errors that possibility of prevention was 89%, and the incidence of moderate or severe harm higher than many other types of event. We have guidelines, training and simulation all directed towards airway safety (this is a good thing). But medication errors generally come second in volume of incidents, frequently lead to harm, and often are preventable – yet our teaching and training in this regard is relatively impoverished. It is a subject that merits continued focus. This piece is followed by two further articles on medication safety. The first, by Dr. Kirsten Joyce, discusses the risks attached to the use of intravenous paracetamol in children. There have been a number of serious incidents involving IV paracetamol reported over the past number of years, leading Children’s Health Ireland to establish a working group to examine possible preventative efforts. Dr. Joyce sits on the working group and presents an overview of the issue. This is followed by an article by Dr Richard Skelly on the commonplace actions of drawing up and administering medications in theatre – something we do many times each day. Yet in each step in this ostensibly mundane process lies the possibility of critical error. Finally, Drs Amy Donnelly & Andrea Haren write about the Sprint National Anaesthesia Projects (SNAP) which examine important themes in perioperative care. SNAP 3, which is planned for early 2022 and involves Ireland for the first time. It will focus on the perioperative care of the older person. Congratulations to Dr Donnelly who recently won the Young Teaching Recognition Award at Euroanaesthesia 2021 for her work on the very topic of SNAP 3.